A Phase-Oriented Treatment Program for PTSD

As part of the Dutch longitudinal research project called Critical Incidents in Police Work, an eclectic manual-based protocol for PTSD was developed and evaluated in a randomized pretest-posttest control group design (publication in preparation). The results showed at posttest and at follow-up that treatment had produced significant improvement in PTSD, in resumption of work and in some comorbid conditions. Whether the treatment is effective in other trauma populations needs further investigation. We elaborate here on the specific content of the treatment. (The English version of the treatment protocol can be obtained from our department on request).

We apply this protocol for treatment of PTSD, following Type I psychotrauma in police officers and victims of rape, disaster and accidents. It consists of individual psychotherapy, comprised of 16 weekly 60-minute sessions. It incorporates several intervention techniques also used in the cognitive behavioral protocols of Foa and Resick. Our approach, however, is a more sharply delineated phase-oriented treatment.

In general, the creation of meaning plays a central role in enabling a person to cope adequately with the trauma:

(1) First a theoretical framework is provided within which the patient learns to understand his PTSD symptoms in relation to the trauma (first session with spouse or other significant person).

(2) Then the patient can start to emotionally work through the trauma by means of imaginary guidance. This involves bringing to the surface the hitherto avoided emotions in a way that is gradually and carefully controlled. At this stage writing assignments and memorabilia are helpfulbut interpretations should not yet be given (Sessions 2 through 6)

(3) Now the patient will be open to insightful interpretations and more existential questions concerning his altered view of the world (Sessions 7 through 9, with spouse at Session 9).

(4) In the next stage, the patient consciously considers what he has learned from the trauma and whether this might have led to a degree of personal growth. This entails an explicit pursuit of positive aspects of the traumatic experience (Sessions 10 through 12).

(5) At the final stage, there is the acceptance of the traumatic experience, as is symbolized in a final farewell ritual (Sessions 13 through 16, with spouse at the last session). With this, the patient leaves the trauma behind and takes an active step into the future. *